This is a complete guide to deep tissue massage (DTM).
In today's guide you'll learn:
- The basics of deep tissue massage
- What the benefits are
- If there are any side effects
- Worlds best techniques
- Comparisons to other massages
In short: if you want to know everything (and more!) about this type of massage therapy, you'll love this guide.
Deep Tissue Massage Basics
In this chapter we will cover deep tissue massage fundamentals.
(Including what it is and how it's practiced)
So if you’re just getting started with DTM, this chapter is for you.
Let’s jump right in.
What is a Deep Tissue Massage?
Massage dates back thousands of years and is the oldest documented form of medical care in the world. Almost everyone has had a massage – even if it wasn’t from a professional massage therapist or masseuse. When you feel pain, your first instinct is to rub the affected area. Guess what; that’s massage!
According to the National Center for Complementary and Integrative Health, 6.9% of U.S. adults (about 15.4 million people) have turned to massage therapy to relieve a wide range of symptoms, from back pain to stress and even for sports injuries.
Over the centuries and across continents, many unique massage systems have been developed, including deep tissue massage, brought to us in the 1800s.
“Deep tissue massage is the manual manipulation of the deeper layers of muscle and fascia.”
Dr. Kimberly Langdon
Your body is an amazing machine. It’s made up of billions of cells, miles of nerves and blood vessels, dozens of organs, over 200 bones, and more than 600 muscles. The muscles themselves are made up of bundles of fibers wrapped together by a connective tissue called fascia – imagine a handful of drinking straws wrapped in clingfilm. Take a few of these bundles and you have the basic structure of muscle tissue.
Injury, inactivity, or stress can cause the muscle fibers and fascia to become scarred and “gummed up.” This may lead to pain and stiffness, and in more serious cases muscle weakness. Deep tissue massage is the manual manipulation of the deeper layers of muscle and fascia. It helps free up fascia and encourages the repair and remodeling of scar tissue, restoring normal muscle function in the process.
To reach the deep muscle tissue and fascia, therapists use firm pressure through their fingers, thumbs, and palms. Depending on the area being treated, they will also use their forearms, elbows, and even knees to get the pressure right down into the deeper tissue. Some therapists make use of specialist tools to concentrate the pressure into smaller, focused areas, but also to relieve their hands.
Deep tissue massage can be a stand-alone treatment or used in conjunction with other types of massage therapies. It can be used locally to treat a specific problem, such as a stiff neck or tight shoulders, or applied more generally to the whole body.
Why it's Good: The Benefits
This chapter is all about the outstanding benefits of any deep tissue treatment: feeling good.
Deep tissue massage can be a stand-alone treatment or used in conjunction with other types of massage therapies.
It can be used locally to treat a specific problem, such as a stiff neck or tight shoulders, or applied more generally to the whole body.
Let's see how you can benefit.
Deep tissue massage addresses the causes of pain, including scar tissue, impaired fascia, poor circulation, accumulated toxins, and muscle tightness. The treatment itself can be uncomfortable and may even be painful. But, afterward, patients usually report that their levels of pain are greatly reduced.
Massage helps to alleviate pain via something called the gate control theory, also known as the pain gate theory. Sensory nerves carry information from your body to your brain. These nerves can only carry a limited amount of information at any one time. What massage does is to effectively replace the pain signals, closing the gate on pain. If the ultimate cause of the pain is not treated, it will eventually return, but deep tissue massage can provide welcome short-term relief.
A 2014 study published in the Scientific World Journal reported that deep tissue massage helped to reduce pain in chronic lower back suffers. The pain-relieving effect was likened to those of nonsteroidal anti-inflammatory drugs, such as Advil (ibuprofen).
Increased range of motion
Scar tissue and gummed-up fascia can prevent muscles from moving as freely as they should. This can reduce your range of motion, leading to pain elsewhere in the body, as nearby muscles and joints take on more work. For example, if you have tight, restricted hamstrings, you may develop lower back pain as a result.
Deep tissue massage can help to restore your range of motion. After reviewing seven different studies involving over 230 participants, a meta-study published in the Journal of Physical Therapy Science revealed that deep tissue massage can significantly improve the range of motion of the shoulder joint. The shoulder is a very complex joint controlled by many muscles, so success here suggests deep tissue massage will have a similar effect on the rest of the body.
Faster recovery from injury
Deep tissue massage can help speed up recovery from a range of soft-tissue injuries, including those in muscles and ligaments. Manipulation of the fascia and fibers helps increase blood flow to the affected area while removing the waste products that may delay recovery. Passive stretching of the affected area can also contribute to faster recovery by preventing adaptive shortening and the formation of scar tissue.
This has been shown to work in studies on rats conducted by the Department of Physical Therapy, School of Health and Rehabilitation Sciences at Indiana University, where instrument-assisted deep tissue massage helped speed up recovery from knee ligament injuries.
Improved function of the heart and lungs
One of the more surprising benefits of deep tissue massage is its effect on cardiovascular health. A study published in the Journal of Alternative and Complementary Medicine reported that deep tissue massage produced a significant reduction in both heart rate and blood pressure after treatments lasting between 45-60 minutes.
Systolic blood pressure was on average 10 mm/Hg lower, while diastolic blood pressure dropped by an average of 5 mm/Hg. The average drop in heart rate was 10 beats per minute.
Massage can also increase lung function, especially in individuals with chronic obstructive pulmonary disease and severe asthma. A study in the International Journal of Chronic Obstructive Pulmonary Disease reports that lung function in study participants increased from 93% to 96% after treatment.
Stress is the perceived inability to cope with the demands of work, home, or both. It can have a significant impact on both mental and physical wellbeing and is a common cause of illness.
Deep tissue massage has been shown to be an effective way to alleviate stress. The treatment eases pain and muscle tension, two common symptoms of stress, and also allows the patient to “unplug” from the stresses of the day.
It can also help alleviate stress-related headaches. In a study published in the Journal of the National Medical Association, participants reported that the average number of tension headaches suffered per week dropped from 6.8 to only two. The majority of subjects also reported that their headaches become less intense and shorter.
The downside: Side effects
Side effects are not uncommon after deep tissue massage, but they are rarely serious.
Because deep tissue massage involves firm, sustained pressure to areas that may already be painful, you may experience lingering muscle soreness in the area that has been treated.
Many people skip this section and wonder why they have certain side effects.
The treatment itself may also be uncomfortable. It is important to communicate with your therapist and let them know how you feel during the massage. There is a big difference between acceptable levels of discomfort and real pain.
You may feel slightly unwell a day or so after treatment, experiencing cold-like symptoms. This is entirely normal. Deep tissue massage speeds up lymphatic drainage and may trigger the release of toxins.
While deep tissue massage is considered safe for the majority of patients, there are a few groups who should avoid or approach this type of treatment with caution. Discuss your treatment with your therapist or doctor if:
You have a history of blood clots or deep vein thrombosis. Deep tissue massage can dislodge blood clots, which could lead to a stroke or heart attack.
You are taking blood thinners. Blood thinners are often used to prevent unwanted clots from forming and in the treatment of heart disease and high blood pressure. They also increase the risk of bruising.
You have a bleeding disorder such as hemophilia. Bleeding disorders mean that you may be more prone to bruising. Deep tissue massage can cause bruising and soreness at the best of times. If you bruise very easily, deep tissue massage could result in severe bruising and unnecessary pain.
You have cancer or are currently undergoing cancer treatment. While gentle massage can be very beneficial, deep tissue massage should not be used without the express permission of your oncologist.
You have osteoporosis. Osteoporosis is a condition characterized by weak, brittle bones. Firm deep tissue massage may be too stressful and could even result in a fracture.
You have an open wound or skin infection. Deep tissue massage should be fine in the unaffected areas, but any open wounds or skin infections should not be treated directly. This will avoid making the injury worse or, in the case of infection, causing it to spread.
You have lymphedema. Lymphedema is swelling that generally occurs in one or both arms or legs. It is commonly caused by the removal of or damage to your lymph nodes as part of cancer treatment. Massage can make the symptoms of lymphedema worse.
If you are unsure as to your suitability for deep tissue massage, you should discuss your concerns with your therapist who may, in turn, suggest you consult your doctor before treatment. Alternatively, if you are at all concerned, speak to your doctor first to make sure that they have no objection to deep tissue massage.
How to do it: Best techniques
The techniques used in deep tissue massage depend on the area and the condition being treated.
While there are some standard techniques, therapists will often develop their own unique ones.
For example, therapists who do a lot of treatments through the day or who are not especially strong may use tools so that they can apply firmer pressure.
That said, there are several types of technique that most deep tissue therapists are likely to use.
Before you start...
Deep tissue massage techniques are quite forceful and, as the name suggests, involve pressing down to the deepest layers of the muscles and fascia.
Before using any of the following techniques, make sure that the target area is warmed up with some light, general massage to increase blood flow and temperature.
This will also provide you with the opportunity to palpate (feel) the area about to be treated, seeking out areas of tension and pain. It also introduces your touch to the patient, building rapport and trust.
Five of the most common deep tissue massage techniques are:
Most massage techniques go “with the grain” to increase blood flow and aid relaxation. Transverse frictions are applied across the target tissue to free up fascia, realign the muscle fibers, and relieve the symptoms of tendonitis. This technique may also help remodel scar tissue.
How to do it: Position yourself so that you are perpendicular to the area to be treated. Apply a light coating of oil to avoid irritating the skin. Press down on the affected area and then move back and forth across it, increasing pressure as you do so. Experiment with using your thumb, fingers, edge, heel, and palm of your hand to see which works best.
Trigger point therapy
Trigger points are hotspots of localized pain. They are often caused by scar tissue as well as gummed-up fascia. Trigger point therapy involves pressing on the hotspot until it "melts" away. This technique can be painful at first, but it soon leads to pain relief. It can be done manually or with a trigger point therapy tool.
How to do it: Palpate the affected area to locate trigger points. Once you have found the painful area, apply pressure with your finger, thumb, or your elbow. Increase the pressure and then maintain it for 30-60 seconds. During this time, the pain should begin to subside. Increase the pressure again. As before, after 30-60 seconds, the pain should subside. Repeat this sequence one more time.
Positional release is often done alongside trigger point treatment. It is a good way to not only reduce pain but restore function and increase the pain-free range of motion.
How to do it: Locate the trigger point and then apply firm but steady pressure to that area. Next, move the affected limb (while maintaining the trigger point) to find a position that causes the pain in the affected area to subside.
Hold the limb in the position at which the pain diminished while maintaining pressure on the hotspot, or even increasing it slightly. Release the trigger point and then put the affected limb back in its original position. Re-palpate the area and you should find the hotspot is much less painful.
Soft tissue release
This technique allows you to stretch a specific part of a muscle to release muscle tension and free up any gummed-up fascia. Regular stretching exercises tend to focus on the middle or belly of the target muscle. Soft tissue release allows you to be much more precise.
How to do it: Relax and then flex (bend) the limb to be treated. Place your hand or forearm across the target muscle, just above the area you want to stretch. Apply moderate pressure – this is called blocking.
Without releasing your block, slowly extend the limb being treated. This will focus the stretch on the area of the muscle beneath the block. Release the block, flex the limb again, and repeat.
This technique involves applying pressure along the entire length of a muscle to free up fascia, increase circulation, and provide a passive stretch for the affected area. Stripping is one of the more painful deep tissue massage techniques, especially when applied to the outer thighs which are often very tight and sensitive.
How to do it: Choose the muscle to be treated and identify its origin (start point) and insertion (endpoint). Position the limb for client comfort and easy access. Next, starting at the origin, apply pressure across the muscle with your thumb, knuckles, heel of your hand, or forearm.
The limb you use will depend on the width of the area you are treating. Apply pressure and then slowly massage along the length of the muscle. Return to the origin, increase the pressure, and repeat.
Comparison with other massage types
All forms of massage involve manual manipulation and stimulation of your muscles and skin.
There are, however, several different types of massage, and each one has its own benefits.
Make sure you know the difference between deep tissue, Swedish, and sports massage so that you get the type of treatment your body really needs.
Versus Swedish massage
Where deep tissue massage involves a lot of pressure and depth, Swedish massage is much gentler, flowing, and more superficial. Deep tissue massage tends to be very prescriptive, and the treatment is designed by the therapist according to the needs and wants of the client.
In contrast, most Swedish massage treatments follow a predetermined routine that lasts between 60-90 minutes and covers the entire body. Swedish massage is a relaxing treatment that offers lots of general benefits. Deep tissue massage is not usually relaxing and can even be painful.
Versus Sports massage
Sports massage uses many of the techniques seen in deep tissue massage but is designed to specifically improve athletic performance, enhance recovery between workouts, and treat or prevent common sports injuries.
A sports massage normally focuses on the larger muscle groups involved in sports, such as the quadriceps, hamstrings, back, and shoulders, and often involves a full body treatment.
In contrast, deep tissue massage is more commonly used to treat a more varied range of ailments and clientele, and just not those related to sports. Deep tissue massage also tends to focus on a smaller area of the body to treat a pre-existing condition.
To summarize: Deep tissue massage uses specialist techniques and firm pressure to manipulate your muscles and the surrounding fascia. Treatments are prescriptive and planned to meet your individual needs. Deep tissue massage is best thought of as a medicinal treatment designed to produce a particular outcome.
Frequently asked questions
Here at The Wellness Council, we get a lot of questions about deep tissue massage.
In this section, we will answer the ten most frequently asked questions so that you can make an informed decision regarding this popular form of treatment.
So, keep reading. We are done soon.
1. What happens during a deep tissue massage?
Before your treatment starts, your therapist will ask you about your general health and any problem areas. This ensures you have no contraindications to massage and allows your therapist to plan your treatment.
When you are ready, you will lie on your stomach or back on a massage couch, covered with a towel sheet, for your modesty and comfort. Only the area being treated is exposed.
The therapist will warm up the area using light massage strokes and oil before working on the affected areas with firmer, stronger techniques. This may involve the use of specialized massage tools. During the treatment, the therapist will ask for your feedback so that they can modify the treatment as they go.
At the end of your treatment, you will be asked how the treated areas feel compared to when the treatment started. You may then be given post-treatment advice and maybe some stretches or exercises to do at home.
2. What should I wear?
Your therapist needs access to the area that needs to be treated. Wear clothing that is comfortable but that can be adjusted to leave the area to be treated uncovered.
Underwear or shorts should always be worn. Deep tissue massage usually involves the use of lubricating oils. Make sure that, whatever you wear, you don’t mind if it gets a little oily.
For more information read our article: What to Wear to a Massage?
3. Does deep tissue massage hurt?
Deep tissue massage can be painful, but it’s pain with a purpose. Muscle pain is often the result of scar tissue. To get rid of scar tissue, massage therapists purposely damage the affected area so that it can be remodeled and repaired without more scaring. This causes pain during the treatment as well as after.
Your therapist will adjust the firmness of your treatment to reflect your tolerance for pain and using a heat pad or a cold pack wrapped in a towel may help to relieve soreness afterward.
It's also important to remember that severe pain is not necessarily an indicator of a successful deep tissue massage treatment. Some therapists pride themselves on giving deep, painful massages, but this is not always a good thing. Make sure you tell your therapist if they are hurting you too much.
4. What should I do after the session?
Firstly, you should always follow the advice of your therapist to make sure that you avoid undoing the effects of your treatment.
For example, you should avoid stressing the area that has just been treated with unnecessary activity. This could delay your recovery.
You may also be given gentle rehabilitation exercises to stretch or strengthen the affected area. After your treatment, you should monitor your pain levels so that you can tell your therapist how your body responded.
5. How long does the massage last?
Most deep tissue massages last between 30-60 minutes. Your initial treatment will usually involve a consultation so your first session may be longer.
The duration of subsequent treatments will depend on the size of the area being treated, and whether any other types of treatment are included. For example, you might have a general lower body massage followed by a more prescriptive deep tissue massage for your lower back.
6. How often should I get a deep tissue massage?
This is a hard question to answer because it depends on the severity of the condition you are having treated and how quickly you recover between treatments. A weekly treatment may be sufficient, or you may need two or more treatments per week.
Some patients get a monthly deep tissue massage as a “tune-up” to avoid developing problems in the future. Others only have deep tissue massage to treat existing problems.
The best person to answer this question is your therapist. They will create a treatment plan based on the issues and symptoms you present.
7. How do I find a good therapist near me?
Deep tissue massage uses some very powerful techniques that should only be used by qualified massage therapists. Improper use of things like trigger point therapy and stripping could make existing injuries worse and not better.
To find a good therapist near you:
- Ask your doctor for recommendations – medical professionals often have referral networks.
- Ask friends and family.
- Ask Facebook friends for a recommendation. You can create social media posts that specifically ask for service recommendations.
- Search use the America Massage Therapy Association’s database of certified therapists.
8. How much does one session cost?
The cost per session depends on several factors, including geographic location, the nature of your symptoms, and how long your treatment will be. Some therapists offer discounts for block bookings.
According to the price tracking site Thumbtack, the average cost for deep tissue massage is between $90 and $110 per session. We asked a few massage studios to confirm the prices, they did. We noticed that a session in a rural location is up to 40% cheaper.
9. I have a cold / flu. Can I still get massaged?
Postpone and reschedule your deep tissue massage if you have any kind of contagious infection or illness. A deep tissue massage might make you feel better, but it could just as likely make you feel worse! In addition, you run the risk of infecting your therapist who, in turn, may infect their other patients.
10. I’m in a lot of pain after my treatment, what should I do?
While some discomfort after deep tissue massage is usual and expected, severe pain is not. It could be that the therapist used too much pressure and has left you with bruises, or you may have an underlying condition or injury that your recent treatment has made worse.
Get in contact with your therapist and tell them how you feel. They should be able to offer advice and may also need to adjust future treatments based on your feedback.
A Word from the Wellness Council
Well done! You just finished reading our comprehensive guide on deep tissue massages.
In the following we are summarzing important information and tell you our opinion.
So, let's get started. In our opinion...
...deep tissue massage can be a very effective treatment for a host of chronic and acute medical problems. From strained muscles to stress and improved sports performance, deep tissue massage can help.
Unlike other types of massage therapies, deep tissue massage is not especially relaxing and can even be painful, but it's pain with a purpose. You might hurt during the treatment but should feel much better shortly afterward.
If you have muscular or joint aches and pains or want to avoid such problems in the future, deep tissue massage is highly recommended.
- All Allied Health Schools - History of Massage Therapy & How It Evolved
- The National Center for Complementary and Integrative Health – Use of Complementary Health Approaches in the U.S.
- Wikipedia – Gate Control Theory
- The Scientific World Journal – Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial
- Journal of Physical Therapy Science – Effectiveness of massage therapy on the range of motion of the shoulder: a systematic review and meta-analysis
- Department of Physical Therapy and the Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University – Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans – The effect of deep-tissue massage therapy on blood pressure and heart rate